Just Say No to Lateral Violence in the Workplace!

Bridgid Joseph
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While it seems like lateral violence, or professional bullying, shouldn’t be happening amongst healthcare professionals, it is sadly some of our realities. Do all nurses know what constitutes lateral violence? Besides saying we don’t approve of it, how can we prevent it?

I hear too often in the nursing world that we "eat our young". This is not OK on quite a few levels, but the biggest concern is how often this happens and, despite the fact that so many of us disagree with this behavior and this sentiment, it still occurs frequently. The fancy term for the behavior of "eating our young" is lateral violence. I have been thinking about this a lot lately: Is that mentality different from other professions where people will clamor all over each other to get ahead?

Not entirely, but it seems totally out of character for nurses, who give care to others and are healers for a living, to be laterally violent to each other. There may be times where we may, perhaps, be a bit short with an MD when we disagree upon a plan/intervention for a patient, or not be best friends with one of our coworkers, that is part of human nature, especially when working in a stressful environment. Who hasn't been under a lot of stress in the middle of an insanely busy shift, and maybe come across as less than pleasant to a co-worker? Saving lives can be stressful business, but that doesn't mean that we should demean one another. Lateral violence refers to a person of higher "power" or status on a unit, bullying or demeaning a co-worker, either through verbal or non-verbally aggressive acts. Usually, if you snap at someone because you are stressed, you will address it and apologize, or make some sort of note that you didn't intend to come across as you did. Lateral violence is a continued trend of behavior that makes others feel uncomfortable, demeaned, and of less value.

The thing about lateral violence is that some of the acts that constitute it, are so subtle. While any administration for any hospital or other healthcare arena would tell you that they take a stance on anti-bullying and/or lateral violence, the behavior and actions can be really tough to nail down, and it has been so long accepted in our culture that it goes under-reported. It's not just the senior nurse on your unit that might get snappy or yell at a newer nurse for not being able to read their mind during an emergent situation, it could be the resource nurse that doesn't schedule a break/lunch time any time that you work with them, or doesn't offer you help when you are drowning in your assignment, but seems to offer to help everyone else out. It's the charge nurse that gives you the heaviest assignment every single shift. It's the person who runs the schedule and they put you on every single shift that you request off. It's the co-worker that ignores you, or rolls their eyes at you, when you ask for help. If you have ever been in a situation at work where you've felt distressed by how you have been treated, you may have been the victim of lateral violence. These actions are what create a toxic environment that leads to a high turnover of nurses, and severely unhappy nurses on the unit in their short time there.

And not only do the clinical staff suffer, but the patients suffer as well. When clinical staff are not working as a team, helping each other when they need it, and giving unequal patient assignments, it can be hard to meet the needs of our patients. If I can't find a co-worker willing to help me reposition my bed bound patients, they are at a higher risk of pressure ulcers, right? And if my assignment is so heavy I don't have time to change out that IV that was due to be changed at the beginning of my shift, that patient is at a much higher risk for phlebitis.

What can we, as a culture of nurses, do about lateral violence? Just saying we won't tolerate it isn't enough. One of the biggest ways to prevent it is to educate staff on what lateral violence actually is; once behaviors are pointed out, and it becomes a part of the culture that those behaviors will be scrutinized and not tolerated, people tend to have more self awareness of their actions. We also need to speak out when we see it occur to others, or experience it directly, and report it. Nurse leaders on units should lead by example and set the tone for their unit, not only that they don't bully their own staff or colleagues, but that they are supported by the policies set forth by their institution, and enforce a culture of anti-lateral violence. And when staff report lateral violence to their managers/directors, they need to feel comfortable and that there will be no repercussions for their actions, and that the person reported will actually be dealt with.

None of us should feel uncomfortable or scared going to work, for any reason, and if you do, you need to speak out about it, and report it higher and higher in your institution until someone listens! Feel empowered to stand up for yourself, your colleagues, and our community.

What I have found is that lateral violence has been inbred into the hospital culture for a very long time. If you are the nurse or aide who speaks up about unfair treatment to your manager or to human resources, you are targeted that much more. The largest part of the problem is promoting nurses into management positions that have not been trained in management and have no management skills. Therefore, they "manage" based on the same bullying, gossip and targeting of employees that they saw their managers practice.

The sad part is that the bullying is rarely about how a patient was treated.

As someone who worked in corporate environments for 20 years before entering the nursing field, I was stunned to find the hospital culture so entrenched and hostile with no protection for employees against unfair disciplinary measures. If the hospital was your first job, then this environment is normal for you.

It is very difficult to change the culture of an organization. Just be prepared for the response if you are the one who tries to effect a change.

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Ruby Vee
has 40 years experience as a BSN and specializes in CCU, SICU, CVSICU, Precepting & Teaching.

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I hear too often in the nursing world that we eat our youngâ€. This is not OK on quite a few levels, but the biggest concern is how often this happens and, despite the fact that so many of us disagree with this behavior and this sentiment, it still occurs frequently. The fancy term for the behavior of eating our youngâ€ is lateral violence. I have been thinking about this a lot lately: Is that mentality different from other professions where people will clamor all over each other to get ahead?

Not entirely, but it seems totally out of character for nurses, who give care to others and are healers for a living, to be laterally violent to each other. There may be times where we may, perhaps, be a bit short with an MD when we disagree upon a plan/intervention for a patient, or not be best friends with one of our coworkers, that is part of human nature, especially when working in a stressful environment. Who hasn't been under a lot of stress in the middle of an insanely busy shift, and maybe come across as less than pleasant to a co-worker? Saving lives can be stressful business, but that doesn't mean that we should demean one another. Lateral violence refers to a person of higher powerâ€ or status on a unit, bullying or demeaning a co-worker, either through verbal or non-verbally aggressive acts. Usually, if you snap at someone because you are stressed, you will address it and apologize, or make some sort of note that you didn't intend to come across as you did. Lateral violence is a continued trend of behavior that makes others feel uncomfortable, demeaned, and of less value.

The thing about lateral violence is that some of the acts that constitute it, are so subtle. While any administration for any hospital or other healthcare arena would tell you that they take a stance on anti-bullying and/or lateral violence, the behavior and actions can be really tough to nail down, and it has been so long accepted in our culture that it goes under-reported. It's not just the senior nurse on your unit that might get snappy or yell at a newer nurse for not being able to read their mind during an emergent situation, it could be the resource nurse that doesn't schedule a break/lunch time any time that you work with them, or doesn't offer you help when you are drowning in your assignment, but seems to offer to help everyone else out. It's the charge nurse that gives you the heaviest assignment every single shift. It's the person who runs the schedule and they put you on every single shift that you request off. It's the co-worker that ignores you, or rolls their eyes at you, when you ask for help. If you have ever been in a situation at work where you've felt distressed by how you have been treated, you may have been the victim of lateral violence. These actions are what create a toxic environment that leads to a high turnover of nurses, and severely unhappy nurses on the unit in their short time there.

And not only do the clinical staff suffer, but the patients suffer as well. When clinical staff are not working as a team, helping each other when they need it, and giving unequal patient assignments, it can be hard to meet the needs of our patients. If I can't find a co-worker willing to help me reposition my bed bound patients, they are at a higher risk of pressure ulcers, right? And if my assignment is so heavy I don't have time to change out that IV that was due to be changed at the beginning of my shift, that patient is at a much higher risk for phlebitis.

What can we, as a culture of nurses, do about lateral violence? Just saying we won't tolerate it isn't enough. One of the biggest ways to prevent it is to educate staff on what lateral violence actually is; once behaviors are pointed out, and it becomes a part of the culture that those behaviors will be scrutinized and not tolerated, people tend to have more self awareness of their actions. We also need to speak out when we see it occur to others, or experience it directly, and report it. Nurse leaders on units should lead by example and set the tone for their unit, not only that they don't bully their own staff or colleagues, but that they are supported by the policies set forth by their institution, and enforce a culture of anti-lateral violence. And when staff report lateral violence to their managers/directors, they need to feel comfortable and that there will be no repercussions for their actions, and that the person reported will actually be dealt with.

None of us should feel uncomfortable or scared going to work, for any reason, and if you do, you need to speak out about it, and report it higher and higher in your institution until someone listens! Feel empowered to stand up for yourself, your colleagues, and our community.

Last edit by tnbutterfly on Sep 7

No "Don't Like" button!

Too often, we hear the term "nurses eat their young", and that's our own fault. Not because we actually EAT our young, but because it's a catchy phrase and a got topic. Put anything about lateral violence, horizontal violence, bullies or nurses eating their young in the title, and the thread gets a lot of attention. I suspect that if we (and I'm guilty here, too) stopped using the phrase it might fade away. There is no more "lateral violence," hazing, bullying or negative interaction in nursing that there is in any other field. The problem, I think, is twofold.

First, there is the myth that nurses are some sort of elevated being who are constantly and endlessly kind, caring and compassionate. Because nurses are such mythical angels, we aren't allowed to have a bad day and snap at a colleague, roll our eyes at the new grad who has asked us for the eleventh time (and it isn't even lunch time yet) for the phone number to pharmacy or hide in a corner to chart. Perhaps this isn't actually news to anyone, but all nurses, regardless of gender, are human. Humans have bad days, get irritated by dumb questions and occasionally roll their eyes.

Second, writers keep selling the idea that lateral violence or bullying is anything that makes the "target" feel uncomfortable. We write that

"If you have ever been in a situation at work where you've felt distressed by how you have been treated, you may have been the victim of lateral violence. These actions are what create a toxic environment that leads to a high turnover of nurses, and severely unhappy nurses on the unit in their short time there."

We warn that the signs of bullying or lateral violence are subtle and easy to overlook, so if you come away from an action feeling distressed about it, you may have been bullied.

The thing is, the majority of new nurses are also new to the professional work place and may not understand professional work relationships. There was a thread started by a brand new nurse who was certain that her preceptor was bullying her because, although the preceptor discussed her family and her personal life with the other senior nurses on the unit, she would not discuss such things with the orientee. Sadly, some of the posters on that thread could not understand why a senior nurse might wish to discuss her personal life with her FRIENDS and not with the new hire she was precepting. I know of a new orientee who was convinced she was being bullied because every time she joined the crowd in the break room for lunch, people quickly made excuses and got up and left. Her table manners were so atrocious that people literally lost their appetites watching her eat, talk with her mouth full and spit crumbs across THEIR food. She was my orientee; I had to have the discussion with her. She not only didn't get the point, she then went to management and accused me of targeting her. "It's not enough that she criticizes my practice, she criticizes my eating, too!" This orientee was new to the work world and, it seems, had never before encountered negative feedback. In school, her parents always "set the teacher straight" if there was an incident where negative feedback might have occurred.

Not every interaction that leaves someone feeling "demeaned" or "disrespected" or somehow bullied is indeed an incident of bullying. I think articles like this one dilute that message. Worse, students and new grads read articles like this one and enter the work world expecting to encounter bullying. We all know that if you go looking for bullies, you will find them -- even if there are no bullies. Sometimes the feeling of being disrespected comes from legitimate negative feedback delivered less than skillfully and while that's unpleasant, it is also necessary. Unfortunately, not every colleague who discovers your error (or even every manager or preceptor) is skillful at negative feedback.

The scheduler who denies all of your requests may indeed not like you. But it's equally possible, especially in a new position, that all of your requests violate the scheduling guidelines for your unit. The schedulers for my unit complain bitterly about new employees who, even though they've been given a written copy of the guidelines and an hour with a scheduler to explain them, the logic behind them, and how to navigate the schedule without violating them still manage to request every Saturday off, fail to put in any night shifts and request off every single holiday that falls on their rotation. The resource nurse who seems never to offer you a break may have already offered you an 11:00 lunch which you refused because it was "too early" and hasn't had a chance to come back to you. Or hasn't come back to you because management suggested that you needed to develop your time management and wanted you to practice negotiating your own break. Or she may have noted that you're sitting and playing with your phone while lights are going off all around you and everyone else is running nonstop.

The coworker who rolls her eyes at you when you ask for help may be having a bad day, may be reacting to the fact that you ALWAYS need help even with a light assignment, may be in the middle of doing something that you should have noticed. Having someone roll their eyes at you isn't pleasant, but it isn't bullying either.

The article sets the standard for bullying too low and then encourages those who are new to the work place (and who may not understand workplace relationships) to stand up for themselves, empower themselves and report it. I fear that there will be many new employees who are empowered to see bullies everywhere (where there aren't any) and to report many negative interactions that aren't bullying. That's not only bad for the senior employees who have to defend their actions "I tried to explain to her that you don't give 20 mEq of KCL IV push", it's bad for the new employee who then develops a reputation in the workplace and may find herself "not fitting in."

There is such a thing as a nurse bully -- I have encountered two of them over the past four decades. But they aren't as prevalent as some articles would have you believe, and the criteria for bullying behavior perhaps ought to be discussed a bit more. Every negative encounter is not an episode of lateral violence, and everyone who dislikes the new employee is not a bully.

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compassionresearcher
has 20 years experience and specializes in Pediatrics, Women's Health, Education.

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This is the topic of my research, but I broaden it to all forms of workplace mistreatment because I think it goes far beyond what nurses do to each other. It's important to recognize there is vertical abuse from docs and admin and even aid to nurse abuse. Plus, I don't like tarnishing our profession's reputation. We need to stand together, no only not mistreat each other, but when we witness it from others, to call it out. Protect and comfort the victim. And to work as a team so that nobody is left vulnerable.

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I am an older nurse/COB. I don't really believe there are large numbers of NETY out there. Maybe some here and there.

As a COB that did not get into management or higher levels, I recognize and experience lateral violence as a staff nurse in the most subtle ways...usually with the assignments. In short, at my job, I believe it is a very, very busy unit and people are saving themselves and their friends/buddies and letting others fight through the shift. It wouldn't be too hard to come up with a better way, perhaps based on acuity....but no one wants to find that way. It seems foreign to them. I have only been at this job for a short period but it seems like forever. They are use to high turn over. I agree that reporting lateral violence begets more lateral violence. Something should change...but I will be long out of nursing by the time that change comes.

I would be surprised if there was anymore of what you are referring to in nursing than any other proffesion in life. I could be wrong, though I hope I am not.

I think what you outlined in your article was well articulated, and I think you identified why it is so hard to eliminate anywhere in life.

Because it isn't obvious. We live in a nation where innocent until proven guilty is a core tennant of our virtues.

Obvious forms of bullying, or abuse I think would promptly be shut down and that person reprimanded.

However if we are talking about cumulative little things that can be hard to notice, and prove. It gets more complicated.

I do believe a bevy of small slights can lead to major repercussions over time, but as I said they are harder to notice.

As a result if such things are ever openly talked about it can become a he said/she said type of affair. Which can be incredibly difficult to properly resolve even for people who tend to be less biased.

That said I would rather deal with that then the guilty until proven innocence types of affairs of the past. At least until some one comes up with a better way to identify, and correct behavior.

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compassionresearcher
has 20 years experience and specializes in Pediatrics, Women's Health, Education.

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When nurses ask what my research is on and I tell them workplace mistreatment, it usually elicits a story of what they're going through. Anecdotally it appears the tide has turned and NETY has become YETO (youngin's eat the old) ;-) Several experienced nurses have shared with me that they feel millennials have different attitudes as newcomers than people who graduated before the year 2000-- when experience was respected. Now the new grads (allegedly, for it is hearsay) are treating the older nurses like they're obsolete or giving them tougher patient assignments because "they should be able to handle it." Again, just what I'm told when I'm standing in line in the cafeteria, I have not actually researched it. But based on how my teenage nieces treat me I'm not surprised

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Not_A_Hat_Person
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When nurses ask what my research is on and I tell them workplace mistreatment, it usually elicits a story of what they're going through. Anecdotally it appears the tide has turned and NETY has become YETO (youngin's eat the old) ;-) Several experienced nurses have shared with me that they feel millennials have different attitudes as newcomers than people who graduated before the year 2000-- when experience was respected. Now the new grads (allegedly, for it is hearsay) are treating the older nurses like they're obsolete or giving them tougher patient assignments because "they should be able to handle it." Again, just what I'm told when I'm standing in line in the cafeteria, I have not actually researched it. But based on how my teenage nieces treat me I'm not surprised

Does anyone tell these experiences nurses that it's their fault? They're too sensitive? They're not skilled enough? They're not trying hard enough to get along with their colleagues? They need to suck it up and quit whining?

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compassionresearcher
has 20 years experience and specializes in Pediatrics, Women's Health, Education.

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Does anyone tell these experiences nurses that it's their fault? They're too sensitive? They're not skilled enough? They're not trying hard enough to get along with their colleagues? They need to suck it up and quit whining?

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